Most Docs Don't Follow Preschooler ADHD Guidelines?

Some specialists turn to medications too soon while others avoid them completely

From the WebMD Archives

By Robert Preidt

HealthDay Reporter

SATURDAY, May 4 (HealthDay News) -- About 90 percent of pediatric specialists who diagnose and manage attention-deficit/hyperactivity disorder (ADHD) in preschool children do not follow treatment guidelines published recently by the American Academy of Pediatrics, according to a new study.

Some prescribe medications too soon, while others do not give the young patients drugs even as a second-line treatment, according to study author Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park, N.Y., and colleagues.

The American Academy of Pediatrics (AAP) guidelines recommend that behavior therapy be the first treatment approach for preschoolers with ADHD, and that treatment with medication should be used only when behavior-management counseling is unsuccessful.

The researchers also found that more than one in five specialists who diagnose and manage ADHD in preschoolers recommend medications as a first-line treatment alone or in conjunction with behavior therapy.

The study is scheduled for Saturday presentation at the Pediatric Academic Societies' annual meeting in Washington, D.C. Data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

"It is unclear why so many physicians who specialize in the management of ADHD -- child neurologists, psychiatrists and developmental pediatricians -- fail to comply with recently published treatment guidelines," Adesman said in a medical center news release.

Some physicians also deviate from guidelines with their choice of medication. Although methylphenidate (Ritalin) is recommended as the first drug to try when medications are warranted, many doctors prescribed other types of drugs.

"With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten," Adesman said. "Primary care physicians and pediatric specialists should recommend behavior therapy as the first-line treatment."

Awareness is lacking across specialties, another study author said.

"Although the AAP's new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," study principal investigator Dr. Jaeah Chung said in the news release.

"At a time when there are public and professional concerns about overmedication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children," Chung added.